5 Fri 130 - Minkoff - Right to choose District II syllabus
Transcript of 5 Fri 130 - Minkoff - Right to choose District II syllabus
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Obstetrical Ethics
The Right to Choose
The Right to Refuse
CONFLICT OF INTEREST DISCLOSURE STATEMENT
• I don’t have financial interest or other relationships with the industry relative to the topics being discussed.
Learning Objective
The illiterate of the 21st century will not be those who cannot read and write, but those who cannot learn, unlearn, and relearn.
Alvin Toffler
unlearn
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Why Do/Don’t We Accept a Woman’s Choice?
• The Facts
• The Fetus
• The Physician
Why Do/Don’t We Accept a Woman’s Choice?
• The Facts
• The Fetus
• The Physician
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What Is Morality?
Morality
Rationalist v. Intuitivist
ReasonRationalize
Morality
Nature
Nurture
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Nature: Babies Have Morals
Nature: Babies Have Morals
Evolutionary Moral Adaptations
Me Us Them
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Morality: a set of psychologicaladaptions that allow otherwiseselfish individuals to reap the
benefits of cooperation
Joshua Greene. Moral Tribes
Evolutionary Moral Adaptations
Me Us Them
Nurture: Neutral, Laudable, Appalling
• Masturbation
• Homosexuality
• Sexual abstinence
• Polygamy
• Abortion
• Circumcision
• Corporal punishment
• Capital Punishment
• Women allowed/no allowed to work
• Islam, Christianity, Judaism
• Capitalism
• Democracy
• Flag burning
• Long hair
• No hair
• Meat consumption
• Alcohol consumption
Richard Schweder
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•Is it how we value Sanctity?
•Is it how we value Community?
•Is it how we value Autonomy?
Nurture: What Makes Us Different?
Autonomy Community Divinity
Shweder, R. A., Much, N. C., Mahapatra, M., & Park, L. [1997]
Domains of Moral Discourse
N Grams (Family, Me)
Chinese
American
Me
Family
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Philippa Foot
“If you talk to a man in a language he understands, that goes to his head. If you talk to him in his language, that goes to his heart.”Nelson Mandela
Ventromedial prefrontal cortex
=
Dorsolateral prefrontal cortex
=
Would You Kill The Fat Man?
No
Yes
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Autonomy Beneficence
“Ethics needs principles—and respect for autonomy should be ‘first
among equals’” R. Gillon
Ethics
N Gram (Autonomy, Beneficence, Do No harm)
Patient and Provider
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Child
Schrödinger's Fetus
Minkoff H, Marshall MF, Liaschenko J. The fetus, the "potential child," and the ethical obligations of obstetricians. Obstet Gynecol. 2014 May;123(5):1100‐3
Abortus
Potential
Hierarchy of Rights/Interests
• Pre-viable1. Mother’s Negative Autonomy
2. Mother’s affirmative Autonomy
3. Fetal
• Viable1. Mother’s Negative Autonomy
2. Fetal
3. Mother’s Affirmative
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Obstetrician's response to the abortion controversy can’t be based on accounts of the independentmoral status of the fetus, because all such accounts are irresolvablydisputable.
Chervenak F, McCullough LB Am J Ob Gyn 1990;163
An Obstetrician’s View
Survey at ACOG
Section Without Consent = 54.5%
Marrow Without Consent = 26.1%
Those who performed a C/S (p=.04) or a marrow (P=<.01) without consent
scored higher on the Sanctity Scale & were more likely to be Male (P =.03
and P=.01 for C/S and marrow respectively)
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Hierarchy of Rights/Interests
• Pre-viable– Mother’s Negative
Autonomy
– Mother’s affirmative Autonomy
– Fetal
• Viable– Mother’s Negative
Autonomy
– Fetal
– Mother’s Affirmative
“Potential Child”
Potential Child
Minkoff H, Marshall MF, Liaschenko J. The fetus, the "potential child," and the ethical obligations of obstetricians. Obstet Gynecol. 2014 May;123(5):1100‐3
Potential Abortus
Fetus
Interests
No InterestsRights
Mother’s Right To Refuse
Fetal Rights
Considerations of Potential Child
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Amniocentesis for Huntington's Chorea
Continue Pregnancy if PositiveAbort if positive
Autonomy
Mother Physician
Negative
NegativePositive
Positive
Potential Child
Morality
Rationalist v. Intuitivist
Reason Rationalize
Morality
1. Nature2. Nurture
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Motivated Reasoning
Can I believe this?
Must I believe this?
Party Over Policy
Cohen GL. Journal of Personality and Social Psychology 2003Vol. 85, No. 5, 808–822
Motivated Reasoning?
B]. Assume the risk of excess death or serious morbidity associated with TOLAC is 1/1,000. Is 1/1,000 an acceptable risk?
*P = <0.001 for A vs. B
A]. Assume the risk of excess death or serious morbidity associated with home birth is 1/1,000. Is 1/1,000 an acceptable risk?
No = 28.9%*
No = 63.9%*
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Eating toastBeating your wifeHaving sex with a Corpse
No Right to Put A Baby at Risk?
• Refused Cesarean Delivery
• Smoking
• Supersizing
• Overworking as a resident
• Left Turns
Morality
Rationalist v. Intuitivist
Reason Rationalization
1. Be aware of bias2. Be concerned about consequences
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Thank You